Covered Entity Details

CH05788A WILL COUNTY COMMUNITY HEALTH CENTER (Active) - information as of 6/21/2025 12:07:12 AM

Main Details

Name

WILL COUNTY COMMUNITY HEALTH CENTER

Subdivision Name

Mobile Medical and Dental Unit

Type

HRSA-Funded Health Center

Site ID

BPS-H80-010960

340B ID

CH05788A

Grant Number

H80CS00476

Additional Details

Current Program Status

Active

Registration Date

4/5/2016

Participating Start Date

7/1/2016

Participating Approval Date

5/25/2016

Last Recertification Date

3/10/2025

Contacts

Authorizing Official

Will County Community Health Center
Stacy Baumgartner, Chief Executive Officer
(815) 740-7635

Primary Contact

Will County Community Health Center
Phil Jass, Quality Risk Management Program Coordinator
(815) 774-7355

Addresses

Street Address

1106 Neal Avenue
Joliet, IL 60433-2548

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WI	448780	1902811714

Shipping Addresses

Shipping Address 1

Will County Community Health Center
1106 Neal Avenue
Joliet, IL 60433

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH057880	Active	BPS-H80-001557	WILL COUNTY COMMUNITY HEALTH CENTER	WILL COUNTY COMMUNITY HEALTH CENTER	1106 Neal Ave	Joliet	IL
CH05788A	Active	BPS-H80-010960	WILL COUNTY COMMUNITY HEALTH CENTER	Mobile Medical and Dental Unit	1106 Neal Avenue	Joliet	IL
CH05788B	Active	BPS-H80-019321	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center - North	323 Quadrangle Drive	Bolingbrook	IL
CH05788C	Active	BPS-H80-027626	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center - East	5601 W. Monee-Manhattan Road STE 109	Monee	IL
CH05788D	Active	BPS-H80-035423	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center Brooks Middle School	350 Blair Ln	Bolingbrook	IL
CH05788E	Active	BPS-H80-038181	WILL CO COMM HEALTH CENTER	Will County Community Health Center at Will County Health Department	501 Ella Ave	Joliet	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH057880	BASINGER'S MADISON PHARMACY	330 N. MADISON STREET	SUITE 102	JOLIET	IL	60435	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY	2130 W JEFFERSON ST		JOLIET	IL	60435-6622	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY INC	DBA BASINGERS CITY CENTER PHARMACY	300 N OTTAWA ST	JOLIET	IL	60432-4009	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY, INC	DBA BASINGER'S WILL COUNTY PHARMACY	1106 NEAL AVE STE A	JOLIET	IL	60433	07/01/2017	01/20/2023
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03929	1801 INGALLS AVE	JOLIET	IL	60435	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04032	466 NELSON ROAD	NEW LENOX	IL	60451	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04948	101 LILY CACHE LANE	BOLINGBROOK	IL	60440	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05386	358 E CASS STREET	JOLIET	IL	60432	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 10772	1163 W. JEFFERSON ST.	JOLIET	IL	60435	01/01/2017
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04460	1295 LILY CACHE LANE	BOLINGBROOK	IL	60490	07/01/2017
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03651	20950 GOVERNORS HWY.	OLYMPIA FIELDS	IL	60461	04/01/2019
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04532	15 S. ORCHARD DR.	PARK FOREST	IL	60466	04/01/2019	03/07/2024
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04949	7209 W. LINCOLN HWY.	FRANKFORT	IL	60423	04/01/2019
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05086	3120 CHICAGO RD	SOUTH CHICAGO HEIGHTS	IL	60411	04/01/2019
CH057880	BUBBLEPACK PHARMACY	2202 ESSINGTON RD	SUITE 104	JOLIET	IL	60435-1634	01/01/2019	01/20/2023
CH057880	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2019
CH057880	GENOA HEALTHCARE LLC	1106 NEAL AVE STE 1211		JOLIET	IL	60433	04/01/2024
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01170	3200 CATON FARM	JOLIET	IL	60431	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04977	2050 NELSON RD.	NEW LENOX	IL	60451	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 00921	1155 W. JEFFERSON ST.	SHOREWOOD	IL	60404	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02936	809 PLAINFIELD RD.	JOLIET	IL	60435	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01773	9551 W. 171ST ST.	TINLEY PARK	IL	60487	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05421	2375 DRAUDEN RD	PLAINFIELD	IL	60586	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05449	11840 S. STATE RTE 59	PLAINFIELD	IL	60585	01/01/2020	04/02/2025
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05822	11200 LINCOLN HWY	MOKENA	IL	60448	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07142	16760 W. DIVISION ST.	LOCKPORT	IL	60441	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07168	1725 WEST BOUGHTON RD.	BOLINGBROOK	IL	60490	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07760	19900 S LA GRANGE RD	MOKENA	IL	60448	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08512	1 MAIN STREET	PARK FOREST	IL	60466	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBS: CVS/PHARMACY #10553	230 S COMET DR.	BRAIDWOOD	IL	60408	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY #10761	1101 S WATER ST	WILMINGTON	IL	60481	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17121	2370 E LINCOLN HWY	NEW LENOX	IL	60451	01/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06789	8645 WOODWARD AVE.	WOODRIDGE	IL	60517	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #10599	245 S BROADWAY ST.	COAL CITY	IL	60416	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16326	2701 PLAINFIELD RD	JOLIET	IL	60435	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08750	4801 N CENTRAL	CHICAGO	IL	60630	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04262	2211 S. EOLA RD.	AURORA	IL	60503	04/01/2022
CH057880	J D BROWN & CO	837 PLAINFIELD RD		JOLIET	IL	60435-4660	01/01/2017	01/02/2017
CH057880	JOLIET PROFESSIONAL PHARMACY CORP	2401 W JEFFERSON ST	SUITE 200	JOLIET	IL	60435	01/01/2017
CH057880	KODO CARE, INC.	2401 W JEFFERSON ST STE 100		JOLIET	IL	60435	07/01/2020
CH057880	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	10/01/2015	10/30/2016
CH057880	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	07/01/2020	06/09/2020
CH057880	PRIMARY PHARMACY INC	DBA BASINGER'S PRIMARY CARE PHARMACY	2025 S. CHICAGO STREET	JOLIET	IL	60436-6043	01/01/2019	01/20/2023
CH057880	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2019	07/12/2023
CH057880	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2020	09/07/2021
CH057880	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2022	07/05/2022
CH057880	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	10/01/2018	02/25/2019
CH057880	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	01/01/2022	07/05/2022
CH057880	WAL-MART PHARMACY 10-3790	16241 S FARREL RD		LOCKPORT	IL	60441	10/01/2018	02/25/2019
CH057880	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2022	07/05/2022
CH057880	WALGREEN CO	DBA: WALGREENS #10374	680 E. BOUGHTON RD	BOLINGBROOK	IL	60440	07/01/2017
CH057880	WALGREEN CO	DBA: WALGREENS #11195	347 N INDEPENDENCE BLVD	ROMEOVILLE	IL	60446-1558	07/01/2017
CH057880	WALGREEN CO	DBA: WALGREENS #10605	1160 W JEFFERSON ST	SHOREWOOD	IL	60404-0703	04/01/2018
CH057880	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	04/01/2023
CH057880	WALGREEN CO.	DBA: WALGREENS #15031	1106 NEAL AVENUE	JOLIET	IL	60433	07/01/2013	08/25/2016
CH057880	WALGREEN CO.	DBA: WALGREENS # 07866	2101 W JEFFERSON ST	JOLIET	IL	60435-6621	01/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 04828	4822 CATON FARM RD	PLAINFIELD	IL	60586	04/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 06563	498 N WEBER ROAD	ROMEOVILLE	IL	60446	04/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 09919	695 W BOUGHTON RD	BOLINGBROOK	IL	60440-1752	07/01/2017	11/13/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 07362	2379 PLAINFIELD RD	CREST HILL	IL	60403	01/01/2018	04/10/2024
CH057880	WALGREEN CO.	DBA: WALGREENS # 06703	16750 W 159TH STREET	LOCKPORT	IL	60441-7968	01/01/2018
CH057880	WALGREEN CO.	DBA: WALGREENS # 07829	680 S WEBER RD	ROMEOVILLE	IL	60446	01/01/2018
CH057880	WALGREEN CO.	DBA: WALGREENS # 07411	3200 VOLLMER ROAD	OLYMPIA FIELDS	IL	60461-1122	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 09326	9554 E LINCOLN HWY	FRANKFORT	IL	60423	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 06180	450 S SCHOOLHOUSE RD	NEW LENOX	IL	60451	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS #13923	1890 SILVER CROSS BLVD STE 120	NEW LENOX	IL	60451	04/01/2019	08/19/2021
CH057880	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15305	912 W BELMONT AVE	CHICAGO	IL	60657	10/01/2023
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2019	11/05/2021
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2019
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2019
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 10:52:33 AM	3/10/2025 7:03:27 PM	3/10/2025 7:03 PM
Contacts	Authorizing Official	Update	AO Change Request	Maragos, Mary Chief Executive Officer Will County Community Health Center 8157407635	Baumgartner, Stacy Chief Executive Officer Will County Community Health Center 8157407635	3/10/2025 6:19 PM
Details	Last Recertification Date	Update	Recertification	2/8/2023 9:22:16 AM	2/6/2024 10:52:33 AM	2/6/2024 10:52 AM
Details	Last Recertification Date	Update	Recertification	2/15/2022 2:29:16 PM	2/8/2023 9:22:16 AM	2/8/2023 9:22 AM
Contacts	Primary Contact	Update	Recertification	Baumgartner, Stacy Director of Operations Will County Community Health Center 8157747375	Jass, Phil Quality Risk Management Program Coordinator Will County Community Health Center 8157747355	2/15/2022 2:29 PM
Details	Last Recertification Date	Update	Recertification	3/9/2021 4:54:32 PM	2/15/2022 2:29:16 PM	2/15/2022 2:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/9/2021 4:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		448780	3/9/2021 4:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	3/9/2021 4:54 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902811714	3/9/2021 4:54 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	3/9/2021 4:54 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 8:13:47 AM	3/9/2021 4:54:32 PM	3/9/2021 4:54 PM
Contacts	Primary Contact	Update	Recertification	Byrd, Jennifer Chief Medical Officer Will County Community Health Center 8157408985	Baumgartner, Stacy Director of Operations Will County Community Health Center 8157747375	1/29/2020 8:13 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 5:54:07 PM	1/29/2020 8:13:47 AM	1/29/2020 8:13 AM
Details	Last Recertification Date	Update	Recertification	2/9/2018 11:13:40 AM	1/29/2019 5:54:07 PM	1/29/2019 5:54 PM
Addresses	Main Address	Update	Change Request	Address Undisclosed Undisclosed, IL 00000	1106 Neal Avenue Joliet, IL 60433-2548	8/3/2018 9:47 AM
Contacts	Primary Contact	Update	Change Request	Edwards, Thomas Director of Operations Will County Community Health Center 8157747375	Byrd, Jennifer Chief Medical Officer Will County Community Health Center 8157408985	8/3/2018 9:47 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/9/2018 11:13:40 AM	2/9/2018 11:13 AM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/9/2018 11:13 AM
Contacts	Primary Contact	Update	Recertification	Edwards, Thomas Director of Operations 8157747375	Edwards, Thomas Director of Operations Will County Community Health Center 8157747375	2/9/2018 11:11 AM
Contacts	Authorizing Official	Update		Maragos, Mary Chief Executive Officer 8157407635	Maragos, Mary Chief Executive Officer Will County Community Health Center 8157407635	9/29/2017 10:07 AM
Contacts	Signed By	Update		Maragos, Mary Chief Executive Officer 8157407635	Maragos, Mary Chief Executive Officer Will County Community Health Center 8157407635	9/29/2017 10:07 AM
Contacts	Authorizing Official	Insert			Maragos, Mary Chief Executive Officer 8157407635	8/7/2017 9:51 AM
Contacts	Signed By	Insert			Maragos, Mary Chief Executive Officer 8157407635	8/7/2017 9:51 AM
Contacts	Primary Contact	Insert			Edwards, Thomas Director of Operations 8157747375	4/28/2017 12:47 PM
Addresses	Main Address	Insert			Address Undisclosed Undisclosed, IL 00000	2/1/2017 2:56 PM
Details	Last Recertification Date	Update			2/1/2017 12:00:00 AM	2/1/2017 2:56 PM
Addresses	Billing Address	Insert			Will County Health Department 501 Ella Avenue Joliet, IL 60433	5/25/2016 11:18 AM
Addresses	Shipping Address	Insert			Will County Community Health Center 1106 Neal Avenue Joliet, IL 60433	5/25/2016 11:18 AM
Dates	Participating Approval Date	Update			5/25/2016 12:00:00 AM	5/25/2016 11:18 AM
Details	State	Update		Pending	Active	5/25/2016 11:18 AM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	5/25/2016 11:18 AM
Details	340B ID	Update		Wait_ONLINE_REG_59001	CH05788A	4/25/2016 1:20 PM
Details	340B ID	Update		ONLINE_REG_59001	Wait_ONLINE_REG_59001	4/7/2016 3:18 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_59001	4/5/2016 11:20 AM
Details	Last Recertification Date	Insert				4/5/2016 11:20 AM
Details	Grant Number	Insert			H80CS00476	4/5/2016 11:20 AM
Details	340B ID	Insert			ONLINE_REG	4/5/2016 11:20 AM
Details	Is Authorizing Official EHB Data	Insert			False	4/5/2016 11:20 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/5/2016 11:20 AM
Details	Medicare Provider Number	Insert				4/5/2016 11:20 AM
Details	Entity Name	Insert			WILL COUNTY COMMUNITY HEALTH CENTER	4/5/2016 11:20 AM
Details	Program Code	Insert			CH	4/5/2016 11:20 AM
Details	Entity Subname	Insert			Mobile Medical and Dental Unit	4/5/2016 11:20 AM
Dates	Participating Approval Date	Insert				4/5/2016 11:20 AM
Details	State	Insert			Pending	4/5/2016 11:20 AM
Dates	Registration Date	Insert			4/5/2016 12:00:00 AM	4/5/2016 11:20 AM
Dates	Signed By Date	Insert			4/5/2016 12:00:00 AM	4/5/2016 11:20 AM
Dates	Start Date	Insert				4/5/2016 11:20 AM
Terminations	Termination Comments	Insert				4/5/2016 11:20 AM
Terminations	Termination Date	Insert				4/5/2016 11:20 AM
Terminations	Termination Effective Date	Insert				4/5/2016 11:20 AM
Terminations	Termination Reason	Insert				4/5/2016 11:20 AM

340B Drug Pricing Program Database